IMI 2023 Digest

Padmaja Sankaridurg, David A Berntsen, Mark A Bullimore, Pauline Cho, Ian Flitcroft, Timothy J Gawne, Kate L Gifford, Monica Jong, Pauline Kang, Lisa A Ostrin, Jacinto Santodomingo-Rubido, Christine Wildsoet, James S Wolffsohn

Research output: Contribution to specialist publication or newspaperEditor of Special issue


Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.

Original languageEnglish
Number of pages26
Specialist publicationInvestigative Ophthalmology and Visual Science
Publication statusPublished - 1 May 2023

Bibliographical note

Copyright © 2023 The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License.


  • clinical management
  • definitions
  • ethical considerations
  • experimental models
  • interventions
  • myopia


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